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Home My WebLink AboutBLDP&G-18-002634 '\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK {a CITY S.Yarmouth k MA DATE! 100471 f- J PERMIT# iNa9P d8' '2& 7 JOBSITE ADDRESS 38 Touraine Way OWNER'S NAME Eileen DuBois POWNER ADDRESS TEL 774-212-2712 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Lj EDUCATIONAL Li RESIDENTIAL E PRINT _ CLEARLY NEW:0 RENOVATION: REPLACEMENT: " PLANS SUBMITTED: YES NO FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB -—IIIIIII 1111. 7- - -_1-- -7-1 I CROSS CONNECTION DEVICE 1111.M1r- I DEDICATED SPECIAL WASTE SYSTEM --muM ((-I DEDICATED GAS/OIUSAND SYSTEM 1 DEDICATED GREASE SYSTEM I 1 I — ` I L DEDICATED GRAY WATER SYSTEM MI _ DEDICATED WATER RECYCLE SYSTEM r— _ — I ' DISHWASHER —11- I ( - aiiir �. DRINKING FOUNTAIN _ I • FOOD DISPOSER �� ,L FLOOR/AREA DRAIN ' — ---7-- INTERCEPTOR(INTERIOR) ' 1___ _ I KITCHEN SINK MIN LAVATORY 111.1 _ j — —:111111111= , ROOF DRAIN r ®� SHOWER STALL — =' 1 SERVICE/MOP SINK I - — . � — I -- � � TOILET - ---- � _1 URINAL WASHING MACHINE CONNECTION f - II 11 WATER HEATER ALL TYPES I WATER PIPING OTHER IMF - ---1- i -- - Mil 1i I ll- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 J OTHER TYPE OF INDEMNITY BOND I I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true a d a urate of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ce ith erti ent provision of the Massachusetts State numbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Keith J. Farnham LICENSE# 11601 SIGNATU MP I JP_ CORPORATION I 1# 3698C PARTNERSHIPI 1 LLC Li# COMPANY NAME South Shore Heating&Cooling, Inc. ADDRESS 57 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 1 508-398-6901 FAX 508-760-2681 CELL EMAIL ? (- \itiA coMb, c-) . , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 Ttit 7 4CITY S.Yarmouth i MA DATE L�Q�a 7�J�- I PERMIT# /�/8'4G�6111 JOBSITE ADDRESS 38 Touraine Way OWNER'S NAME Eileen Dubois GOWNER ADDRESS TEL 774-212-2712 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL 71 PRINT RESIDENTIAL CLEARLY NEW: , RENOVATION: REPLACEMENT:Li ' PLANS SUBMITTED: YES ) NO APPLIANCES 1 FLOORS BSM 1 2 3 4 5 7 8 9 10 11 12 13 14 BOILER I ;i —, BOOSTER r I CONVERSION BURNER COOK STOVE ! 1 ' DIRECT VENT HEATER __ ! DRYER r i FIREPLACES j J FRYOLATOR I L : _ FURNACE rI GENERATOR [ _GRILLE I .1!INFRARED HEATER LABORATORY COCKS _MAKEUP AIR UNIT [ - _ OVEN [ I 1 { — POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST ! . UNIT HEATER UNVENTED ROOM HEATER _ WATER HEATER OTHER I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ; NO I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY / OTHER TYPE INDEMNITY ,rl1 BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 1 AGENT L..... SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ccu to to the best o y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia wit al rtinenTpr sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Keith J. Farnham 1 LICENSE# 11601 SIGNATURE MPH i I MGF E JP JGF LPGI J CORPORATION I /j#13698C a PARTNERSHIP; VI j LLC J# COMPANY NAME; South Shore Heating &Cooling. Inc I ADDRESS White's Path CITY South Yarmouth _ STATE rMA___j ZIP L02664 TEL 508 398 6901 FAX 508-760-2681 I CELL EMAIL